Quality Assurance Specialist

PRIMARY FUNCTION

The Quality Assurance (QA) Specialist is responsible for evaluating the quality, accuracy, and effectiveness of patient interactions across the Patient Contact Center (PCC). This role conducts structured quality monitoring of calls and digital interactions to ensure adherence to clinical protocols, operational workflows, regulatory requirements, and organizational standards.

The QA Specialist analyzes performance data to identify trends, root causes, and opportunities to improve First Call Resolution (FCR), Customer Satisfaction (CSAT), and access to care.

The QA Specialist partners closely with Operations, Training, Workforce Management (WFM), and Leadership to identify performance gaps, deliver actionable insights, and support continuous improvement initiatives that enhance access, accuracy, and overall service delivery.

ESSENTIAL DUTIES AND RESPONSIBILITIES

This list may not include all the duties that may be assigned.

Quality Monitoring & Evaluation

• Conduct structured evaluations of inbound and outbound calls, chats, and other patient interactions to assess:

• Accuracy and completeness of information provided

• Adherence to scripts, workflows, and clinical protocols

• Compliance with company policies, regulatory requirements, and payer guidelines

• Effectiveness in resolving patient needs (FCR)

• Empathy, professionalism, and communication quality

• Complete a minimum number of evaluations per agent per month as defined by leadership

• Utilize standardized QA scorecards aligned to PCC priorities (Access, Scheduling Accuracy, Clinical Triage, etc.)

Performance Tracking & Reporting

• Compile, track, and maintain QA scores at the agent, team, and enterprise levels

• Assist with the Identification of trends, root causes, and performance gaps across:

• Call types (appointments, referrals, billing, clinical advice)

• Regions, skills, and programs

• Develop and distribute weekly and monthly QA performance reports, including insights tied to:

• CSAT drivers

• FCR opportunities

• Access and availability compliance

  
  

Calibration & Quality Governance

• Participate in weekly calibration sessions to ensure scoring consistency across:

• Internal QA team

• BPO partners (e.g., Philippines)

  
  

Confidentiality and Compliance

• Maintain strict confidentiality of all patient, employee, and organizational information in accordance with HIPAA regulations and company policies

• Safeguard all Protected Health Information (PHI), ensuring it is accessed, used, and disclosed only as appropriate and authorized

• Protect the confidentiality of call recordings, call interactions, and any related documentation

• Maintain confidentiality of agent performance data, quality evaluations, and performance outcomes

• Complete all required HIPAA and compliance training and consistently apply learned standards in daily responsibilities

  
  

SUPERVISORY RESPONSIBILITIES

None.

QUALIFICATIONS

EDUCATION: High Scholl Diploma/GED or equivalent required. Bachelor’s degree in business, Healthcare Administration, or related field preferred

EXPERIENCE

• Minimum 3 years of call center or customer service experience required

• Minimum 2 years of quality assurance or quality monitoring experience preferred

• Experience working with regulated environments (e.g., healthcare compliance standards) preferred

  
  

KNOWLEDGE, SKILLS, AND ABILITIES

• Demonstrated ability to review and interpret quality and performance data to identify trends, patterns, and areas for improvement

• Understanding of quality calibration methodology and scoring consistency practices

• Familiarity with automated call distribution (ACD), IVR, and skill-based routing systems

• Experience with EHR systems and cloud-based contact center platforms (e.g., Talkdesk) preferred

• Excellent verbal, written, and interpersonal communication skills

• Strong attention to detail, accuracy, and timeliness

• Ability to work collaboratively in a team-oriented environment

TYPICAL WORKING CONDITIONS

• Non-patient facing

• Hybrid/telework

• If remote, this job must be U.S. based.

• % travel required if any – 0%

  
  

OTHER PHYSICAL REQUIREMENTS

• Vision

• Sense of sound

• Sense of touch

• Work may require sitting for long periods of time

• Manual dexterity sufficient to operate a keyboard

• Long periods of time in front of a computer screen

  
  

PERFORMANCE REQUIREMENTS

Adhere to all organizational information security policies and protect all sensitive information including but not limited to ePHI and PHI (Protected Health Information) in accordance with organizational policy, Federal, State, and local regulations.

The foregoing description is not intended and should not be construed to be an exhaustive list of all responsibilities, skills, efforts or working conditions associated with the job. It is intended to be an accurate reflection of the general nature of level of the job.